APC 5523
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Level 3 Imaging without Contrast
Low
$211
Average
$540
Median
$242
High
$2.8k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
43 hospitals; the 90th percentile is 5.9× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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43 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Aspirus Divine Savior Hospital Portage, WI other · outpatient | 1 | $233 | $233 | — | — | 1–10 | $233 – $233 |
| 2 | Aspirus Eagle River Hospital Eagle River, WI other · outpatient | 1 | $1.3k | $1.3k | — | — | 1–10 | $1.3k – $1.3k |
| 3 | Aspirus Iron River Hospital Iron River, MI other · outpatient | 1 | $1.4k | $1.4k | — | — | 1–10 | $1.4k – $1.4k |
| 4 | Aspirus Keweenaw Hospital Laurium, MI other · outpatient | 1 | $2.4k | $2.4k | — | — | 1–10 | $2.4k – $2.4k |
| 5 | Aspirus Langlade Hospital Antigo, WI other · outpatient | 1 | $1.1k | $1.1k | — | — | 1–10 | $1.1k – $1.1k |
| 6 | Aspirus Medford Hospital Medford, WI other · outpatient | 1 | $2.8k | $2.8k | — | — | 1–10 | $2.8k – $2.8k |
| 7 | Aspirus Merrill Hospital Merrill, WI other · outpatient | 1 | $1.1k | $1.1k | — | — | 1–10 | $1.1k – $1.1k |
| 8 | Aspirus Plover Hospital Stevens Point, WI other · outpatient | 1 | $230 | $230 | — | — | 1–10 | $230 – $230 |
| 9 | Aspirus Rhinelander Hospital Rhinelander, WI other · outpatient | 1 | $246 | $246 | — | — | 1–10 | $246 – $246 |
| 10 | Aspirus St. Luke’s Hospital Duluth, MN other · outpatient | 1 | $242 | $242 | — | — | 35 | $242 – $242 |
| 11 | Aspirus Stanley Hospital Stanley, WI other · outpatient | 1 | $2.0k | $2.0k | — | — | 1–10 | $2.0k – $2.0k |
| 12 | Aspirus Stevens Point Hospital Stevens Point, WI other · outpatient | 1 | $230 | $230 | — | — | 1–10 | $230 – $230 |
| 13 | Aspirus Wausau Hospital Wausau, WI other · outpatient | 1 | $230 | $230 | — | — | 21 | $230 – $230 |
| 14 | Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI other · outpatient | 1 | $230 | $230 | — | — | 1–10 | $230 – $230 |
| 15 | CORNING HOSPITAL Corning, NY facility · fee schedule · outpatient | 1 | $242 | $242 | — | — | — | $242 – $242 |
| 16 | Canton-Potsdam Hospital Potsdam, NY facility · other · outpatient | 1 | $306 | $306 | — | — | 49 | $306 – $306 |
| 17 | Clifton Springs Hospital And Clinic Clifton Springs, NY facility · other · outpatient | 1 | $286 | $286 | — | — | 1–10 | $286 – $286 |
| 18 | El Camino Hospital Los Gatos, CA other · outpatient | 1 | $354 | $354 | — | — | 18 | $354 – $354 |
| 19 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · fee schedule · outpatient | 1 | $242 | $242 | — | — | — | $242 – $242 |
| 20 | Gouverneur Hospital Gouverneur, NY facility · other · outpatient | 1 | $1.1k | $1.1k | — | — | 50 | $1.1k – $1.1k |
| 21 | Logan Health - Conrad Conrad, MT other · outpatient | 1 | $933 | $933 | — | — | 1–10 | $933 – $933 |
| 22 | Logan Health - Whitefish Whitefish, MT other · outpatient | 1 | $796 | $796 | — | — | 16 | $796 – $796 |
| 23 | Logan Health Medical Center Kalispell, MT other · outpatient | 1 | $259 | $259 | — | — | 22 | $259 – $259 |
| 24 | Massena Hospital Inc Massena, NY facility · other · outpatient | 1 | $306 | $306 | — | — | 1–10 | $306 – $306 |
| 25 | McLeod Health Dillon, SC case rate · outpatient | 1 | $211 | $211 | — | — | — | $211 – $211 |
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